Biomedical subjects

S Zisook

Publications and source records attributed to S Zisook.

At least 37 records · Page 2Linked to original sources

PubMed1997

Is it possible to be schizophrenic yet neuropsychologically normal?

This study identified and characterized a group of schizophrenic patients without neuropsychological (NP) impairment. A comprehensive NP battery was administered to 171 schizophrenic outpatients and 63 normal comparison participants. Each participant's NP status was classified through blind clinical ratings by 2 experienced neuropsychologists; 27% of the schizophrenics were classified as NP normal. The NP-normal and NP-impaired schizophrenics were similar in terms of most demographic, psychiatric, and functional characteristics, except that NP-normal patients had less negative and extrapyramidal symptoms, were on less anticholinergic medication, socialized more frequently, and were less likely to have had a recent psychiatric hospitalization. The existence of NP-normal schizophrenics suggests that the pathophysiology underlying the cognitive deficits often associated with schizophrenia may be distinct from that causing some of its core psychiatric features.

Adult↗

PubMed1997

Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: psychosocial outcomes.

OBJECTIVE: The purpose of this study was to determine the effects of antidepressant pharmacotherapy on mood symptoms and psychosocial outcomes in dysthymia. METHOD: In a multicenter, double-blind, parallel-group trial, 416 patients with a diagnosis of early-onset primary dysthymia (DSM-III-R) of at least 5 years' duration without concurrent major depression were randomly assigned to 12 weeks of acute-phase therapy with sertraline, imipramine, or placebo. The psychosocial outcome measures used in the study were the Global Assessment of Functioning Scale, the Social Adjustment Scale, the Longitudinal Interval Follow-up Evaluation psychosocial ratings, and the Quality of Life Enjoyment and Satisfaction Questionnaire. RESULTS: Sertraline and imipramine were significantly better than placebo in improving psychosocial outcomes as measured by the first three instruments. The Quality of Life Enjoyment and Satisfaction Questionnaire scores demonstrated significant improvements from baseline, and both active treatments produced significantly greater improvements than placebo. Significantly fewer patients discontinued sertraline (6.0%) than discontinued imipramine (18.4%) because of adverse events. CONCLUSIONS: Pharmacotherapy is an effective treatment for dysthymia in terms of psychosocial functioning as well as depressive symptoms, even when the dysthymia is long-standing.

1-Naphthylamine↗

PubMed1997

A preliminary study on the efficacy of sertraline and imipramine on anger attacks in atypical depression and dysthymia.

There is clinical and biological evidence suggesting that patients with anger attacks, sudden spells of anger accompanied by intense autonomic activation, may represent a distinct psychopathological subgroup of patients with depressive disorders. We compared the prevalence of anger attacks in 168 outpatients with atypical depression or primary dysthymia with 38 normal subjects and tested the effect of treatment on anger attacks in a double-blind, placebo-controlled trial of sertraline versus imipramine. Patients were randomly assigned to sertraline (n = 56), imipramine (n = 52), or placebo (n = 60) and were administered the Anger Attacks Questionnaire before and after treatment. Depressed outpatients were significantly more likely to report anger attacks than controls. Anger attacks ceased in 53 percent of the patients receiving sertraline, 57 percent of those receiving imipramine, and 37 percent of those in the placebo group. Our findings support previous studies indicating that anger attacks are more prevalent among depressed outpatients than normals. Our results also suggest that sertraline and imipramine may be more effective than placebo in reducing the number of anger attacks following treatment although the differences were not statistically significant. Larger studies are needed to confirm our findings.

1-Naphthylamine↗

PubMed1997

Neuropsychological performance of HIV-1 infected men with major depression. HNRC Group. HIV Neurobehavioral Research Center.

This study sought to determine if human immunodeficiency virus-type 1 (HIV-1) infected depressed men were more likely to be neuropsychologically impaired than their nondepressed counterparts. Subjects were 47 HIV-1 infected men who met DSM-III-R criteria for current major depressive disorder (MDD) and 47 HIV-1 infected nondepressed male controls (M age = 34.2 years) equated on HIV-1 disease severity, demographics, and drug use. The psychiatric interview included the Structured Clinical Inventory for the DSM-III-R, and Hamilton Rating Scale for Depression. The neuropsychological battery included tests covering 8 functional domains based on an expanded Halstead-Reitan Battery. The medical assessment included a history and physical examination, immunologic staging, and evaluation of prescription and recreational drug use. Prevalence of global neuropsychological impairment in the two groups (depressed vs. control) did not differ [53% vs. 38% respectively; chi 2(1, N = 94) = 2.11, p > .05]. While syndromically depressed patients performed less well than nondepressed individuals on memory tests [delayed retention portions of the Story Memory Test: F(1,91) = 5.34, p < .05; and Figure Memory Test: F(1,90) = 4.16, p < .05], the majority of depressed participants (64%) did not have clinically impaired memory. No relationship between neuropsychological impairment and severity of depression was observed. The results suggest that, while HIV-1 infected men with major depression may perform more poorly than nondepressed men on some aspects of memory tasks, they are not more likely to evidence clinically significant neurocognitive impairment.

Adult↗

PubMed1996

Comparison of descriptive variables for symptomatic volunteers and clinical patients with anxiety disorders.

Worry about the generalizability of findings derived from clinical trials is a nagging problem. Because most clinical trials use individuals recruited by advertisements rather than patients solicited from clinical practice, bias in subject recruitment is a major concern. This paper compares and contrasts the demographic characteristics, symptomatologies, functional disabilities, health beliefs, and health expectations of clinical outpatients to those of subjects recruited from the media (symptomatic volunteers) for pharmacologic trials. Clinical patients were slightly younger, better educated, wealthier, and were more likely to be married. They had more recent exposure to benzodiazepines and antidepressants and were more likely to view their current condition as amenable to psychotherapy. They were more likely to feel that their symptoms would get worse without some type of treatment and to believe that treatment would cure them. The symptomatic volunteers had more presenting symptoms than the clinical patients. The two groups had similar Sheehan Disability Scale scores. These results suggest that further study is warranted of the characteristics of clinical patients and symptomatic volunteers.

Adult↗

PubMed1996

A comparison of descriptive variables for clinical patients and symptomatic volunteers with depressive disorders.

Uncertainty about the generalizability of results from clinical trials is a nagging issue plaguing psychiatric research. The possible bias introduced by the use of subjects recruited from advertisements is one source of concern. Investigators question whether these subjects are representative of the types of individuals who seek treatment in clinical practice. This article compares and contrasts demographic characteristics, functional disabilities, symptomatologies, and the health beliefs and expectations of a cohort seeking treatment at a university outpatient clinic with a cohort of symptomatic volunteers recruited by advertisements. These two groups were alike in most variables; however, the clinical subjects reported more recent exposure to psychotropic medications and were more likely to indicate that they wanted psychotherapy. The symptomatic volunteers were slightly older, endorsed more psychiatric symptoms, drank more alcohol, and believed that combined pharmacology and psychotherapy would most help them. These findings suggest that the two cohorts were remarkably similar on most variables.

Adult↗

PubMed1996

Dating and remarriage over the first two years of widowhood.

In this study we examined the following: (1) frequencies of remarrying or becoming romantically involved for widows and widowers during the first 2 years of widowhood; (2) attitudes toward dating and remarriage among the recently widowed, and their evolution; (3) identifiable factors which predict the development of new romances, such as sex, age, income, and level of education; and (4) the psychological well-being of those widows and widowers involved in romances compared to those who were not. The San Diego Widowhood Project was a prospective study in which 249 widows and 101 widowers who were identified through San Diego County death certificates completed detailed questionnaires 2, 7, 13, 19, and 25 months after their spouses' deaths. The main outcome measures for this study were marital and romance status, attitudes toward romance at several time points, demographic predictors of romance status, and self-reported measures of psychological well-being. By 25 months after the spouse's death 61% of men and 19% of women were either remarried or involved in a new romance. Women expressed more negative feelings about forming new romantic relationships. Younger age was a predictor of becoming involved in a new romance for women, and higher monthly income and level of education were predictors for men. Greater psychological well-being was highly correlated with being remarried or in a new romance 25 months after the spouse's death. It may be helpful for family, friends, and therapists to know that dating and remarriage are common and appear to be highly adaptive behaviors among the recently bereaved.

Adaptation, Psychological↗

PubMed1996

Depression in late life. Diagnosis, course, and consequences.

Both major depression and dysthymia are common disorders in late life. However, making an accurate diagnosis may be more challenging than diagnosing depression in younger persons both because of comorbid general medical conditions and because of the illnesses, cognitive disturbances, and myriad adverse life experiences the elderly face. Often, dysphoria is sloughed off as an understandable response to adversity, and the diagnosis of depression is missed. Thus, elderly persons with major depression and dysthymia may be exposed to unnecessary prolonged suffering and to the disruptions of family life, impairment of functioning, worsening of comorbid general medical illness, and premature death that are the hallmarks of untreated depression.

Aged↗

PubMed1996

Depression in late life. Special considerations in treatment.

In late life, depression and dysthymia are prevalent, serious, but treatable disorders. Unfortunately, treatment often is delayed or withheld because of difficulties in recognizing and diagnosing the condition. Treatment may also be withheld when the depression is incorrectly perceived as hopeless or its treatment as futile. Optimal treatment includes educating the patient and family about depression and its treatment, selecting the appropriate antidepressant regimen, and providing psychosocial intervention to instill hope, improve compliance, and minimize disability. Treatment must be geared toward not only helping patients get well but helping them keep well.

Aged↗

PubMed1995

The nature of learning and memory impairments in schizophrenia.

The California Verbal Learning Test was used to characterize the learning and memory impairment in schizophrenia (SC) and to evaluate potential clinical and demographic factors associated with this impairment. SC patients (n = 175) performed worse than normal comparison (NC) subjects (n = 229) on all learning, recall, and recognition memory measures. The most important clinical correlates of these impairments were earlier age of onset, more negative symptoms, and greater anticholinergic medication dosage. SC patients showed a prominent retrieval deficit as indicated by disproportionate improvement when tested in a recognition, rather than a free recall, format. A residual impairment seen with recognition testing suggests a mild encoding deficit as well. In contrast, the relative absence of a storage deficit is suggested by the lack of rapid forgetting. Using a discriminant function analysis that differentiates cortical dementia [i.e., Alzheimer's disease (AD)], subcortical dementia [i.e., Huntington's disease (HD)], and normals, it was found that 50% of the SC patients were classified as having a subcortical memory profile and 35% were classified as having a normal profile, whereas only 15% were classified as having a cortical memory profile. Although these findings reflect the clinical heterogeneity often found in SC, results suggest that most SC patients demonstrate a pattern of learning and memory impairments that resembles the pattern seen in patients with primary subcortical (specifically striatal) pathology.

Adult↗

PubMed1995

Psychiatric morbidity associated with acquired immune deficiency syndrome-related grief resolution.

This study examined acquired immune deficiency syndrome (AIDS)-related grief resolution and psychiatric morbidity in 286 human immunodeficiency virus (HIV)-positive and HIV-negative gay men examined between 1989 and 1993 in San Diego, CA. Psychiatric morbidity, mood ratings, and bereavement assessments were obtained using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scales for Depression and Anxiety, and Texas Revised Inventory of Grief. Sixty percent of the men (N = 171) reported a loss within the previous 12 months. Eighteen percent of the bereaved met criteria for unresolved grief. No differences were evident in lifetime psychiatric disorders, yet men with unresolved grief demonstrated an elevated prevalence of current major depression and panic disorder when compared with resolved grievers. Clinician sensitivity to the grief process and its relationship to psychiatric complications is an important component of comprehensive psychiatric and medical care of men at high risk for HIV during this era of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Gender differences in schizophrenia.

In an assessment of gender differences in schizophrenia, 85 outpatients (53 men and 32 women) with schizophrenia were evaluated for illness history, symptom severity, IQ, neurocognitive status, cerebral volume loss, and cortical asymmetry. Social functioning was assessed using marital status, independent living skills, and employment status. Significant gender differences were found, as women were on lower doses of neuroleptic medications and more frequently met criteria for paranoid and disorganized subtypes of schizophrenia than men. Women also were better educated and more often married, living independently, and employed. No gender differences were found in present age, symptom severity, neurocognitive functioning, or clinical magnetic resonance imaging scan readings. Our findings suggest that women may experience less of the adverse interpersonal psychosocial consequences of schizophrenia than men, even when symptom and neurocognitive status is equivalent between groups. However, more extensive investigations are warranted to better understand the role of pathophysiological or social mechanisms in gender differences.

Activities of Daily Living↗

PubMed1995

Command hallucinations in outpatients with schizophrenia.

BACKGROUND: The presence of command hallucinations in individuals with schizophrenia may result in an increase in clinical monitoring to reduce the perceived risk of violent behavior. However, the issue of whether command hallucinations hold any clinical relevance in relatively stable outpatient samples has not been established. METHOD: The clinical and research records of individuals with schizophrenia who participated in outpatient research protocols at the University of California, San Diego were reviewed for the presence of command hallucinations. Information on clinical characteristics was collected in a detailed chart review from 106 patient records. RESULTS: Command hallucinations were reported by one half of all patients with auditory hallucinations, and these hallucinations often were violent in content. Yet, in over a third of the patients, these hallucinations had not been documented in their clinical charts, but instead were uncovered during a secondary source review. Patients with command hallucinations generally did not differ on prognostic or clinical course variables. However, the 2 patients who committed suicide during the study were patients with command hallucinations. CONCLUSION: Although command hallucinations may be more frequent than clinicians generally note, in most cases they have minimal influence on the outcome of schizophrenia. However, in outpatients with schizophrenia who have a history of suicide attempts, suicidal command hallucinations should be taken seriously.

Adult↗

PubMed1995

A comparison of demographic variables, symptom profiles, and measurements of functioning in symptomatic volunteers and an outpatient clinical population.

There is consistent concern about the generalizability of research findings generated by clinical trials. There are several reasons for concern about these findings: (1) most clinical trials involve symptomatic volunteers who are recruited by means of advertisements rather than patients recruited from general clinical populations; (2) most clinical trials have restrictive criteria for admission into the study; and (3) the design of most trials is not representative of prescribing practices in the community. These methodological issues require investigators to question whether results from trials adequately model what will be seen in a general clinical situation. This report begins to evaluate the representativeness of initial samples by studying the demographic characteristics, symptom profiles, and measurements of functional disability for clinical outpatients and symptomatic volunteers recruited for clinical trials. We found that symptomatic volunteers were statistically more likely to be older than outpatients, were less likely to be single, and reported using more alcohol and cigarettes than outpatients. The two groups had similar levels of functional impairment and similar ages at onset of symptoms, but symptomatic volunteers reported more symptoms of depression and anxiety than outpatients. However, we believe the differences identified in this study did not seem to be clinically significant.

Adult↗

PubMed1994

Neuropsychological deficits in schizophrenics. Relationship to age, chronicity, and dementia.

BACKGROUND: We sought to determine whether neuropsychological impairment in schizophrenia is related to current age, age at onset, or duration of illness, and whether the pattern of such impairment can be distinguished from that caused by progressive dementias of Alzheimer's type. We administered a comprehensive neuropsychological test battery to a normal control group (n = 38), a group of ambulatory patients with Alzheimer's disease (n = 42), and three ambulatory schizophrenic groups: early onset-young (n = 85), early onset-old (n = 35), and late onset (n = 22). Tests were grouped and analyzed according to eight major ability areas, and published procedures were used to remove the expected effects of normal aging. RESULTS: The three schizophrenic groups were found to be neuropsychologically similar to one another and different from normal controls and patients with Alzheimer's disease. There were no significant differences among the schizophrenic groups in level or pattern of neuropsychological functioning. Patients with Alzheimer's disease demonstrated less efficient learning and particularly more rapid forgetting than did the other groups. CONCLUSIONS: These findings suggest that neuropsychological impairment in schizophrenia is unrelated to current age, age at onset, or duration of illness. The study further suggests that the encephalopathy associated with schizophrenia is essentially nonprogressive and produces a pattern of deficits that is different from that seen in progressive cortical dementias.

Adult↗

PubMed1994

Bereavement, depression, and immune function.

This study evaluates whether recently widowed women who fulfill criteria for a depressive syndrome differ in their immune responses from widows who do not. Twenty-one middle-aged widows who had lost their spouses 2 months before the initial evaluation and 21 demographically matched married women were evaluated at approximately 6-month intervals for 13 months. Evaluations consisted of diagnostic interviews using the Schedule for Affective Disorders and Schizophrenia, Hamilton Rating Scale for Depression, and Beck Depression Inventory. Immune function was measured by total lymphocyte counts, natural killer (NK) cell activity, mitogen responsiveness to concanavalin A, and T-cell subsets. There were no statistically significant differences on any of the immune measures between the entire cohort of widows and control subjects. However, the subset of widows who met DSM-III-R criteria for major depressive syndromes demonstrated impaired immune function (lower NK cell activity and lower mitogen stimulation) compared with those who did not meet criteria for major depression. This study suggests a relationship between impaired immune function and depression in women experiencing the stress of bereavement.

Aged↗

PubMed1994

Reported suicidal behavior and current suicidal ideation in a psychiatric outpatient clinic.

One thousand consecutive intakes at an outpatient psychiatric clinic were screened for past suicide attempts and present suicidal ideation and diagnosed using DSM-III-R criteria. A full range of thoughts about death and suicide were prevalent in all diagnostic groups. Over one-third of patients with major depression and borderline personality disorder had actual plans to kill themselves, and over two-thirds of patients with borderline personality disorder had made one or more suicide attempts.

Adult↗

PubMed1994

Saccadic system functioning among schizophrenia patients and their first-degree biological relatives.

In Study 1, 30 schizophrenia Ss and 27 nonpsychiatric comparison Ss were presented with a fixation task, a visually guided reflexive saccade (prosaccade) task, a predictive tracking task (0.4-Hz square wave), and an antisaccade task. The 2 groups did not differ on either the fixation or prosaccade tasks. Schizophrenia Ss had an increased number of errors on the antisaccade task and had decreased rightward visually guided saccade amplitudes during the predictive tracking task. In Study 2, 13 psychiatric comparison Ss and 32 first-degree biological relatives of the schizophrenia Ss were compared with the schizophrenia Ss and a larger and older sample of nonpsychiatric Ss (n = 33) on the predictive tracking and antisaccade tasks. The groups did not differ on predictive saccadic tracking. The schizophrenia Ss and their first-degree biological relatives made more errors on the antisaccade task than both the nonpsychiatric and psychiatric comparison groups (who did not significantly differ). Results are consistent with the notion that dysfunction of dorsolateral prefrontal cortex, caudate nucleus, or both is related to liability for schizophrenia.

Adult↗